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Old 06-19-2012, 11:04 PM   #1
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Unhappy Treatment options for very early PCa detection

While my thinking still has one foot in "watchful waiting" with my PSA at 6.9, the reality is that my visit with Dr. Bahn revealed in my biopsy that I am in stage T2a with a Gleason score of 4+3=7. (Refer to my postings in "PSA: Active Surveillance - or 2nd Opinion??" for more information).

Thus, my tumor has moved to the next level and I need to decide on next steps.

Treatment options for very early PCa detection are not discussed in detail in the various books I have read and it looks like focal cryoablation recommended by Dr. Bahn - and can be performed by him - is a viable treatment option.

I am reviewing the various other treatment options for treating very early PCa and their side effects in light of my now identified stage and Gleason score.

If you have any insights or considerations not mentioned in my other thread/postings, I'd appreciate your thoughts and feedback.

CowboySailor

 
Old 06-20-2012, 04:56 AM   #2
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Re: Treatment options for very early PCa detection

Hi again,

We are fortunate that Dr. Bahn is tracking his results with focal cryo carefully and publishing them. As he is a recognized pioneer with this approach and an expert with color Doppler ultrasound (CDU), the results should give us a good indication whether the approach works well in various kinds of fairly low-risk cases.

One concern with any focal approach is whether the same environment within the prostate where the cancer grew is common to other areas of the prostate, making it likely that very small tumors may be growing there too and may not be eliminated when the focal cryo is done. On the other hand, expert CDU imaging may be capable of detecting the vast majority of tumors in the prostate.

This is more than an academic issue for me, as it is possible that focal cryo could work in my own case. However, while it appears my cancer has been down staged after years of hormonal therapy, with the prostate now fairly small and normal per DRE, that same prostate was once rock hard - fully packed with cancer. In my case, a cancer fostering environment at one time extended throughout the prostate. I wish I could be assured that that has changed. I suspect there is a spectrum of possibilities, with your case at the favorable end of the spectrum and my case, if not at the other end, at least in a doubtful zone.

Dr. Bahn's work will help answer these questions, but I'm not sure how close we are to these answers.

These are just my thoughts. It's likely you are much more familiar with CDU and focal cryo technology in Dr. Bahn's hands than I am at this point.

Take care,

Jim

 
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Old 06-20-2012, 12:40 PM   #3
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Re: Treatment options for very early PCa detection

Jim,
While there were three dark spots that turned out to >> not << be carcinogenic, it was one of the spots that he knew where 80% of all cancer tends to start that was found to be carcinogenic. I am sure another urologist using standard ultrasound would not have found this tumor/cancer without the research and historical background of Dr. Bahn.

My wife, who was present the entire time with Dr. Bahn, and I feel in very good hands with Dr. Bahn. I just need to understand the side-effects better and their probability of focal cryoablation, as well as also look at the other treatment options to make sure I left no stone unturned.

So when Dr. Bahn say that there is a less than 10% chance of ED in my case, I see the glass half empty and consider that I could be one in the 10%. I'm not that lucky as otherwise I would not be in this predicament.

Thanks for your insights.

Hans

Last edited by Administrator; 06-22-2012 at 10:00 AM.

 
Old 06-20-2012, 02:30 PM   #4
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Re: Treatment options for very early PCa detection

Hi Hans,

Dr. Bahn's CDU work really impresses me! I plan to call his staff to see if CDU might still work for me. On the other hand, I also want to know whether PC has penetrated the capsule, and other imaging would be needed for that answer. For my own case, it makes sense that the latter imaging should be done first as the CDU would be unnecessary if the capsule has been penetrated. (I was considered stage 3 back in early 2000 and had a prostate packed full with cancer.)

Regarding the odds and your feeling about them, my belief is that many of us feel this way as a kind of protective shield so we will not be too disappointed if we are not in the group of patients who do well, which is the vast majority in this case. While I am generally optimistic, I too have experienced the reaction you have had. I do believe that our attitude sometimes makes a difference, but that's a lot less likely when powerful forces are at work, whether for good or for ill. For instance, consider that the spring, in all its fulness of renewed growth, is extremely likely to follow the winter, and our attitudes are not going to influence this cycle. That's the kind of force I have in mind. I hope this line of thought helps you; it has helped me a number of times.

Regarding your earlier thread, you could edit your original post below or add a new reply that would reference your earlier thread. That would tie your concerns together.

Take care,

JIm

Last edited by Administrator; 06-22-2012 at 10:01 AM.

 
Old 06-21-2012, 02:25 PM   #5
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Re: Treatment options for very early PCa detection

Jim,

Just got the written results from Dr. Bahn.

Question: I thought focal cryoablation would treat part (focal/target) of a lobe, not the entire left lobe?

Do you have anymore details?

If the left lobe is treated, wouldn't one want to treat the right lobe as well? Otherwise, the tumor could potentially grow in the right lobe and one would have to do focal cryoablation again.

Or is the thinking to minimize the impact and see what happens in the future and hope the tumor does not appear again?

The terminology is not clear (focal cryoablation vs. targeted focal therapy vs. cryotherapy) to me and I am putting together a list of questions for Dr. Bahn so I understand better what the overall (current + future) risk is, plus side effects. Plus the need for any additional post-treatment (e.g. radiation) to reduce potential future occurrence.

Like everyone else here, I think we have had enough surprises to last each one of us a lifetime.

Hans

 
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